New Challenges for Private Practice model Pediatric Radiology. By Yoginder N. Vaid,M.D.

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2 New Challenges for Private Practice model Pediatric Radiology By Yoginder N. Vaid,M.D.

3 No financial disclosures.

4 Private Practice Pediatric Radiology - Last bastion of General Radiology. - Everyone did everything. - Smaller group, busy but simple practice, lots of revenue. - Work hard, Play hard. Lots of vacation. - Attractive to younger fellows, no academic pressures. - Times have changed, new challenges.

5 About Our Practice Children s of Alabama at Birmingham. 325 bed Children s Hospital, over 2 million sq. feet, 3 rd largest Children s hospital in the nation. The only Children s hospital of the state. Level one trauma center. Liver, Renal and cardiac transplant center Congenital Heart surgical center. Sixth busiest Pediatric ED. Tertiary care Pediatric surgery, neurosurgery, urology, Nephrology, GI, Endocrinology

6 About our Practice Over144,000 imaging examinations in2015. Eight full time Pediatric Radiologists. One part time Radiologist. About 18,000 per Radiologist Interventional service provided by UAB IR group at our IR suite. ( M-F day time only). Our group has to cover some IR work on weekends. Cardiac MRI, CT by 3 radiologist. All radiologists cover all other aspects of Imaging including Neuroradiology. Usual conferencing: Neurology/Neurosurgery, Pediatric Surgery, Pediatric Tumor board, Neuro tumor board, ED, MSK, PICU, NICU, GI, Epilepsy and Urology conferences.

7 About Our Practice

8 About our Practice Over144,000 imaging examinations in2015. Eight full time Pediatric Radiologists. One part time Radiologist. About 18,000 per Radiologist Interventional service provided by UAB IR group at our IR suite. ( M-F day time only). Our group has to cover some IR work on weekends. Cardiac MRI, CT by 3 radiologist. All radiologists cover all other aspects of Imaging including Neuroradiology. Usual conferencing: Neurology/Neurosurgery, Pediatric Surgery, Pediatric Tumor board, Neuro tumor board, ED, MSK, PICU, NICU, GI, Epilepsy and Urology conferences.

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10 About our Practice Over144,000 imaging examinations in2015. Eight full time Pediatric Radiologists. One part time Radiologist. About 18,000 per Radiologist Interventional service provided by UAB IR group at our IR suite. ( M-F day time only). Our group has to cover some IR work on weekends. Cardiac MRI, CT by 3 radiologists. All radiologists cover all other aspects of Imaging including Neuroradiology. Usual conferencing: Neurology/Neurosurgery, Pediatric Surgery, Pediatric Tumor board, Neuro tumor board, ED, MSK, PICU, NICU, GI, Epilepsy and Urology conferences.

11 Cardiac CT: 3D with color coding

12 About our Practice Over144,000 imaging examinations in2015. Eight full time Pediatric Radiologists. One part time Radiologist. About 18,000 per Radiologist Interventional service provided by UAB IR group at our IR suite. ( M-F day time only). Our group has to cover some IR work on weekends. Cardiac MRI, CT by 3 radiologists. All radiologists cover all other aspects of Imaging including Neuroradiology. Usual conferencing: Neurology/Neurosurgery, Pediatric Surgery, Pediatric Tumor board, Neuro tumor board, ED, MSK, PICU, NICU, GI, Epilepsy and Urology conferences.

13 About Our Practice How we manage to do it? While each radiologist covers and work on equal basis. Each is in charge of a section and an internal expert and teach residents and fellows in that section.( Neuro, MSK, Cardiac, GI, Urology, fetal imaging etc.) Each is in charge of a modality also.( CT, MR, US, NM, Fluoro.) Call is equally shared. Night CT work covered by Residents. US, MR, X-rays, Fluoro. covered by attending Radiologist on call.

14 About our Practice Pros: Efficiency Autonomy Financial benefits Vacation, benefits Clinical work, teaching, no academic pressures

15 About our Practice Cons: Busy: over 18,000 exams per radiologist. Increasingly complex practice. Demands for sub-specialty expertise and excellence: Neuro, MSK, Oncology. Recruitment and retention Support from Hospital: Equipment, Financial. Expenses for the group: Billing, benefits

16 Functional MRI

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18 DTI

19 Tectagraphy

20 New Challenges Cons: Busy: over 18,000 exams per radiologist. Increasingly complex practice. Demands for sub-specialty expertise and excellence: Neuro, Cardiac, MSK, Oncology. Recruitment and retention Support from Hospital: Equipment, Financial. Expenses for the group: Billing, benefits

21 Cardiac CT: 3D with color coding: Right arch, isolated Left Subclavian Artery

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23 Cardiac CT: Pulmonary Sling

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26 New Challenges Cons: Busy: over 18,000 exams per radiologist. Increasingly complex practice. Demands for sub-specialty expertise and excellence: Neuro, Cardiac, MSK, Oncology. Recruitment and retention Support from Hospital: Equipment, Financial. Expenses for the group: Billing, benefits

27 Recruitment and Retention - Cannot just hire a Pediatric Radiology fellow with I year training. - Have to have more than one fellowships to do the job : Few and in demand. - Or hire an experienced faculty from some other group: not easy and expensive. - Alternative pathway fellows: Additional issues. - Decreasing salary differential between Academic and Private practice.

28 New Challenges Cons: Busy: over 18,000 exams per radiologist. Increasingly complex practice. Demands for sub-specialty expertise and excellence: Neuro, Cardiac, MSK, Oncology. Recruitment and retention Support from Hospital: Equipment, Financial. Expenses for the group: Billing, benefits

29 Support from Hospital - Hospital have their own financial issues: decreasing Medicaid funding, increased regulations, RCOs. - Previously we got support for short durations when we hired new faculty. - Not so easy now. We take a cut with each recruitment. - Support for equipment : No problems yet.

30 New Challenges Cons: Busy: over 18,000 exams per radiologist. Increasingly complex practice. Demands for sub-specialty expertise and excellence: Neuro, Cardiac, MSK, Oncology. Recruitment and retention Support from Hospital: Equipment, Financial. Expenses for the group: Billing, benefits

31 Expenses for the group: Billing, benefits - Collection expense: 6-10%. - Not so for academic departments. - Benefit Package: Malpractice, health, disability, Life insurance, Retirement. - with part time workers: benefit costs more of an issue.

32 Summary.Increasingly complex services delivered..increased demands for Subspecialty Radiologists..With senior members retiring or going part time, recruitment becoming challenging..cannot hire 1 year fellowship trained Pediatric Fellow to come in and perform in this model..applicants with multiple fellowships are either expensive or want to work in academic departments. Some may have Visa issues.. Decreasing revenues and support from Hospital administration.. Would like to know how others are handling these issues.